Work

#114 - Early Antimicrobial Therapy Reduces Mortality in Acute-on-chronic Liver Failure With Fever

Year: 2026

Type: article

Abstract: Introduction and Objectives Acute-on-chronic liver failure (ACLF) is characterized by rapid hepatic deterioration in patients with chronic liver disease, accompanied by extrahepatic organ failure and high short-term mortality. Bacterial infections are the most common precipitating factor; however, the impact of early antimicrobial therapy on outcomes remains unclear. The objective was to compare in-hospital mortality in patients with ACLF and fever according to whether antimicrobial treatment was initiated within the first 6 hours of hospital admission or later. Materials and Methods Retrospective, observational, comparative cross-sectional study including adult patients admitted to the Internal Medicine and Emergency departments at Hospital General Dr. Manuel Gea González between January 2018 and January 2025. Inclusion criteria were age 18 years, ACLF diagnosis, documented fever (38°C), and available records of the first antimicrobial dose. Patients with prior antibiotic use or severe immunosuppression were excluded. Survival analysis using Cox proportional hazards regression was performed. Results 178 patients were included (mean age 55.2 ± 13.1 years; 63% female). Overall in-hospital mortality was 53.5%. Alcohol-related liver disease was the most common etiology (47%). The main infection sites were urinary tract (48%), pneumonia (25%), and spontaneous bacterial peritonitis (14%). Each additional hour of antibiotic delay increased mortality hazard by 0.9% (HR 1.009; 95% CI: 1.005–1.013; p<0.001). Antibiotic initiation 6 hours after admission was associated with nearly six-fold higher mortality risk (HR 5.99; 95% CI: 3.10–11.59; p<0.001). Conclusions In patients with ACLF and infection, delayed antimicrobial therapy was significantly associated with increased in-hospital mortality. Early antibiotic initiation should be prioritized in institutional protocols.

Source: Annals of Hepatology

DOI: 10.1016/j.aohep.2026.102372